Abstract
IntroductionMicrovascular alterations may play an important role in the development of organ failure in critically ill patients and especially in sepsis. Recent advances in technology have allowed visualization of the microcirculation, but several scoring systems have been used so it is sometimes difficult to compare studies. This paper reports the results of a round table conference that was organized in Amsterdam in November 2006 in order to achieve consensus on image acquisition and analysis.MethodsThe participants convened to discuss the various aspects of image acquisition and the different scores, and a consensus statement was drafted using the Delphi methodology.ResultsThe participants identified the following five key points for optimal image acquisition: five sites per organ, avoidance of pressure artifacts, elimination of secretions, adequate focus and contrast adjustment, and recording quality. The scores that can be used to describe numerically the microcirculatory images consist of the following: a measure of vessel density (total and perfused vessel density; two indices of perfusion of the vessels (proportion of perfused vessels and microcirculatory flow index); and a heterogeneity index. In addition, this information should be provided for all vessels and for small vessels (mostly capillaries) identified as smaller than 20 μm. Venular perfusion should be reported as a quality control index, because venules should always be perfused in the absence of pressure artifact. It is anticipated that although this information is currently obtained manually, it is likely that image analysis software will ease analysis in the future.ConclusionWe proposed that scoring of the microcirculation should include an index of vascular density, assessment of capillary perfusion and a heterogeneity index.
Highlights
Microvascular alterations may play an important role in the development of organ failure in critically ill patients and especially in sepsis
We proposed that scoring of the microcirculation should include an index of vascular density, assessment of capillary perfusion and a heterogeneity index
Given this high variability in image analysis and given the importance it may have in separating diseased from nondiseased states [3,5,8] and in evaluating the effects of interventions [4,9,10,11,12,13], we organized a round table conference to discuss the various aspects of image acquisition and analysis, and used Delphi methodology to formulate a consensus statement
Summary
Microvascular alterations may play an important role in the development of organ failure in critically ill patients and especially in sepsis. Because the microcirculation is the primary site of oxygen and nutrient exchange, therapeutic interventions aimed at increasing organ perfusion should be accompanied by improved microvascular perfusion. The orthogonal polarization spectral (OPS) [1] and the sidestream dark field (SDF) [2] imaging devices both provide high contrast images of the microvasculature. Both devices are based on the principle that green light illuminates the depth of a tissue (up to 3 mm, according to the manufacturer) and that the scattered green light is absorbed by haemoglobin of red blood cells contained in superficial vessels
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